➢ Maternal and child bullets review ➢ According to Kübler-Ross, the five stages of ➢
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death and dying are denial, anger, bargaining, depression, and acceptance. Flight of ideas is an alteration in thought processes that’s characterized by skipping from one topic to another, unrelated topic. La belle indifférence is the lack of concern for a profound disability, such as blindness or paralysis that may occur in a patient who has a conversion disorder. Moderate anxiety decreases a person’s ability to perceive and concentrate. The person is selectively inattentive (focuses on immediate concerns), and the perceptual field narrows. A patient who has a phobic disorder uses selfprotective avoidance as an ego defense mechanism. In a patient who has anorexia nervosa, the highest treatment priority is correction of nutritional and electrolyte imbalances. A patient who is taking lithium must undergo regular (usually once a month) monitoring of the blood lithium level because the margin between therapeutic and toxic levels is narrow. A normal laboratory value is 0.5 to 1.5 mEq/L. Early signs and symptoms of alcohol withdrawal include anxiety, anorexia, tremors, and insomnia. They may begin up to 8 hours after the last alcohol intake. Al-Anon is a support group for families of alcoholics. The nurse shouldn’t administer chlorpromazine (Thorazine) to a patient who has ingested alcohol because it may cause oversedation and respiratory depression. Lithium toxicity can occur when sodium and fluid intake are insufficient, causing lithium retention. An alcoholic who achieves sobriety is called a recovering alcoholic because no cure for alcoholism exists To help a mother break the suction of her breast-feeding infant, the nurse should teach her to insert a finger at the corner of the infant’s mouth. Administering high levels of oxygen to a premature neonate can cause blindness as a result of retrolental fibroplasia. Amniotomy is artificial rupture of the amniotic membranes. During pregnancy, weight gain averages 25 to 30 lb (11 to 13.5 kg). Rubella has a teratogenic effect on the fetus during the first trimester. It produces abnormalities in up to 40% of cases without interrupting the pregnancy. Immunity to rubella can be measured by a hemagglutination inhibition test (rubella titer). This test identifies exposure to rubella infection and determines susceptibility in pregnant women. In a woman, a titer greater than 1:8 indicates immunity.
➢ When used to describe the degree of fetal
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descent during labor, floating means the presenting part isn’t engaged in the pelvic inlet, but is freely movable (ballotable) above the pelvic inlet. When used to describe the degree of fetal descent, engagement means when the largest diameter of the presenting part has passed through the pelvic inlet. Fetal station indicates the location of the presenting part in relation to the ischial spine. It’s described as –1, –2, –3, –4, or –5 to indicate the number of centimeters above the level of the ischial spine; station –5 is at the pelvic inlet. Fetal station also is described as +1, +2, +3, +4, or +5 to indicate the number of centimeters it is below the level of the ischial spine; station 0 is at the level of the ischial spine. During the first stage of labor, the side-lying position usually provides the greatest degree of comfort, although the patient may assume any comfortable position. During delivery, if the umbilical cord can’t be loosened and slipped from around the neonate’s neck, it should be clamped with two clamps and cut between the clamps. An Apgar score of 7 to 10 indicates no immediate distress, 4 to 6 indicates moderate distress, and 0 to 3 indicates severe distress. To elicit Moro’s reflex, the nurse holds the neonate in both hands and suddenly, but gently, drops the neonate’s head backward. Normally, the neonate abducts and extends all extremities bilaterally and symmetrically, forms a C shape with the thumb and forefinger, and first adducts and then flexes the extremities. Pregnancy-induced hypertension (preeclampsia) is an increase in blood pressure of 30/15 mm Hg over baseline or blood pressure of 140/95 mm Hg on two occasions at least 6 hours apart accompanied by edema and albuminuria after 20 weeks’ gestation. Positive signs of pregnancy include ultrasound evidence, fetal heart tones, and fetal movement felt by the examiner (not usually present until 4 months’ gestation Goodell’s sign is softening of the cervix. Quickening, a presumptive sign of pregnancy, occurs between 16 and 19 weeks’ gestation. Ovulation ceases during pregnancy. Any vaginal bleeding during pregnancy should be considered a complication until proven otherwise. To estimate the date of delivery using Nägele’s rule, the nurse counts backward 3 months from the first day of the last menstrual period and then adds 7 days to this date. At 12 weeks’ gestation, the fundus should be at the top of the symphysis pubis. Cow’s milk shouldn’t be given to infants younger than age 1 because it has a low
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linoleic acid content and its protein is difficult for infants to digest. If jaundice is suspected in a neonate, the nurse should examine the infant under natural window light. If natural light is unavailable, the nurse should examine the infant under a white light. The three phases of a uterine contraction are increment, acme, and decrement. The intensity of a labor contraction can be assessed by the indentability of the uterine wall at the contraction’s peak. Intensity is graded as mild (uterine muscle is somewhat tense), moderate (uterine muscle is moderately tense), or strong (uterine muscle is boardlike). Chloasma, the mask of pregnancy, is pigmentation of a circumscribed area of skin (usually over the bridge of the nose and cheeks) that occurs in some pregnant women. The gynecoid pelvis is most ideal for delivery. Other types include platypelloid (flat), anthropoid (apelike), and android (malelike). Pregnant women should be advised that there is no safe level of alcohol intake. The frequency of uterine contractions, which is measured in minutes, is the time from the beginning of one contraction to the beginning of the next. Vitamin K is administered to neonates to prevent hemorrhagic disorders because a neonate’s intestine can’t synthesize vitamin K. Before internal fetal monitoring can be performed, a pregnant patient’s cervix must be dilated at least 2 cm, the amniotic membranes must be ruptured, and the fetus’s presenting part (scalp or buttocks) must be at station –1 or lower, so that a small electrode can be attached. Fetal alcohol syndrome presents in the first 24 hours after birth and produces lethargy, seizures, poor sucking reflex, abdominal distention, and respiratory difficulty. Variability is any change in the fetal heart rate (FHR) from its normal rate of 120 to 160 beats/minute. Acceleration is increased FHR; deceleration is decreased FHR. In a neonate, the symptoms of heroin withdrawal may begin several hours to 4 days after birth. In a neonate, the symptoms of methadone withdrawal may begin 7 days to several weeks after birth. In a neonate, the cardinal signs of narcotic withdrawal include coarse, flapping tremors; sleepiness; restlessness; prolonged, persistent, high-pitched cry; and irritability. The nurse should count a neonate’s respirations for 1 full minute. Chlorpromazine (Thorazine) is used to treat neonates who are addicted to narcotics. The nurse should provide a dark, quiet environment for a neonate who is experiencing narcotic withdrawal.
➢ In a premature neonate, signs of respiratory ➢
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distress include nostril flaring, substernal retractions, and inspiratory grunting. Respiratory distress syndrome (hyaline membrane disease) develops in premature infants because their pulmonary alveoli lack surfactant. Whenever an infant is being put down to sleep, the parent or caregiver should position the infant on the back. (Remember back to sleep.) The male sperm contributes an X or a Y chromosome; the female ovum contributes an X chromosome. Fertilization produces a total of 46 chromosomes, including an XY combination (male) or an XX combination (female). The percentage of water in a neonate’s body is about 78% to 80%. To perform nasotracheal suctioning in an infant, the nurse positions the infant with his neck slightly hyperextended in a “sniffing” position, with his chin up and his head tilted back slightly. Organogenesis occurs during the first trimester of pregnancy, specifically, days 14 to 56 of gestation. After birth, the neonate’s umbilical cord is tied 1" (2.5 cm) from the abdominal wall with a cotton cord, plastic clamp, or rubber band. Gravida is the number of pregnancies a woman has had, regardless of outcome. Para is the number of pregnancies that reached viability, regardless of whether the fetus was delivered alive or stillborn. A fetus is considered viable at 20 weeks’ gestation. An ectopic pregnancy is one that implants abnormally, outside the uterus. The first stage of labor begins with the onset of labor and ends with full cervical dilation at 10 cm. The second stage of labor begins with full cervical dilation and ends with the neonate’s birth. The third stage of labor begins after the neonate’s birth and ends with expulsion of the placenta. In a full-term neonate, skin creases appear over two-thirds of the neonate’s feet. Preterm neonates have heel creases that cover less than two-thirds of the feet. The fourth stage of labor (postpartum stabilization) lasts up to 4 hours after the placenta is delivered. This time is needed to stabilize the mother’s physical and emotional state after the stress of childbirth. At 20 weeks’ gestation, the fundus is at the level of the umbilicus. At 36 weeks’ gestation, the fundus is at the lower border of the rib cage. A premature neonate is one born before the end of the 37th week of gestation. Pregnancy-induced hypertension is a leading cause of maternal death in the United States.
➢ A habitual aborter is a woman who has had ➢ ➢
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three or more consecutive spontaneous abortions. Threatened abortion occurs when bleeding is present without cervical dilation. A complete abortion occurs when all products of conception are expelled. Hydramnios (polyhydramnios) is excessive amniotic fluid (more than 2,000 ml in the third trimester). Stress, dehydration, and fatigue may reduce a breast-feeding mother’s milk supply. During the transition phase of the first stage of labor, the cervix is dilated 8 to 10 cm and contractions usually occur 2 to 3 minutes apart and last for 60 seconds. A nonstress test is considered nonreactive (positive) if fewer than two fetal heart rate accelerations of at least 15 beats/minute occur in 20 minutes. A nonstress test is considered reactive (negative) if two or more fetal heart rate accelerations of 15 beats/minute above baseline occur in 20 minutes. A nonstress test is usually performed to assess fetal well-being in a pregnant patient with a prolonged pregnancy (42 weeks or more), diabetes, a history of poor pregnancy outcomes, or pregnancy-induced hypertension. A pregnant woman should drink at least eight 8-oz glasses (about 2,000 ml) of water daily. When both breasts are used for breastfeeding, the infant usually doesn’t empty the second breast. Therefore, the second breast should be used first at the next feeding. A low-birth-weight neonate weighs 2,500 g (5 lb 8 oz) or less at birth. A very-low-birth-weight neonate weighs 1,500 g (3 lb 5 oz) or less at birth. When teaching parents to provide umbilical cord care, the nurse should teach them to clean the umbilical area with a cotton ball saturated with alcohol after every diaper change to prevent infection and promote drying. Teenage mothers are more likely to have lowbirth-weight neonates because they seek prenatal care late in pregnancy (as a result of denial) and are more likely than older mothers to have nutritional deficiencies. Linea nigra, a dark line that extends from the umbilicus to the mons pubis, commonly appears during pregnancy and disappears after pregnancy. Implantation in the uterus occurs 6 to 10 days after ovum fertilization. Placenta previa is abnormally low implantation of the placenta so that it encroaches on or covers the cervical os. In complete (total) placenta previa, the placenta completely covers the cervical os. In partial (incomplete or marginal) placenta previa, the placenta covers only a portion of the cervical os.
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Abruptio placentae is premature separation of a normally implanted placenta. It may be partial or complete, and usually causes abdominal pain, vaginal bleeding, and a boardlike abdomen. Cutis marmorata is mottling or purple discoloration of the skin. It’s a transient vasomotor response that occurs primarily in the arms and legs of infants who are exposed to cold. The classic triad of symptoms of preeclampsia are hypertension, edema, and proteinuria. Additional symptoms of severe preeclampsia include hyperreflexia, cerebral and vision disturbances, and epigastric pain. Ortolani’s sign (an audible click or palpable jerk that occurs with thigh abduction) confirms congenital hip dislocation in a neonate. The first immunization for a neonate is the hepatitis B vaccine, which is administered in the nursery shortly after birth. If a patient misses a menstrual period while taking an oral contraceptive exactly as prescribed, she should continue taking the contraceptive. If a patient misses two consecutive menstrual periods while taking an oral contraceptive, she should discontinue the contraceptive and take a pregnancy test. If a patient who is taking an oral contraceptive misses a dose, she should take the pill as soon as she remembers or take two at the next scheduled interval and continue with the normal schedule. If a patient who is taking an oral contraceptive misses two consecutive doses, she should double the dose for 2 days and then resume her normal schedule. She also should use an additional birth control method for 1 week. Eclampsia is the occurrence of seizures that aren’t caused by a cerebral disorder in a patient who has pregnancy-induced hypertension. In placenta previa, bleeding is painless and seldom fatal on the first occasion, but it becomes heavier with each subsequent episode. Treatment for abruptio placentae is usually immediate cesarean delivery. Drugs used to treat withdrawal symptoms in neonates include phenobarbital (Luminal), camphorated opium tincture (paregoric), and diazepam (Valium). Infants with Down syndrome typically have marked hypotonia, floppiness, slanted eyes, excess skin on the back of the neck, flattened bridge of the nose, flat facial features, spadelike hands, short and broad feet, small male genitalia, absence of Moro’s reflex, and a simian crease on the hands. The failure rate of a contraceptive is determined by the experience of 100 women for 1 year. It’s expressed as pregnancies per 100 woman-years.
➢ The narrowest diameter of the pelvic inlet is ➢ ➢ ➢
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the anteroposterior (diagonal conjugate). The chorion is the outermost extraembryonic membrane that gives rise to the placenta. The corpus luteum secretes large quantities of progesterone. From the 8th week of gestation through delivery, the developing cells are known as a fetus. In an incomplete abortion, the fetus is expelled, but parts of the placenta and membrane remain in the uterus. The circumference of a neonate’s head is normally 2 to 3 cm greater than the circumference of the chest. After administering magnesium sulfate to a pregnant patient for hypertension or preterm labor, the nurse should monitor the respiratory rate and deep tendon reflexes. During the first hour after birth (the period of reactivity), the neonate is alert and awake. When a pregnant patient has undiagnosed vaginal bleeding, vaginal examination should be avoided until ultrasonography rules out placenta previa. After delivery, the first nursing action is to establish the neonate’s airway. Nursing interventions for a patient with placenta previa include positioning the patient on her left side for maximum fetal perfusion, monitoring fetal heart tones, and administering I.V. fluids and oxygen, as ordered. The specific gravity of a neonate’s urine is 1.003 to 1.030. A lower specific gravity suggests overhydration; a higher one suggests dehydration. The neonatal period extends from birth to day 28. It’s also called the first 4 weeks or first month of life. A woman who is breast-feeding should rub a mild emollient cream or a few drops of breast milk (or colostrum) on the nipples after each feeding. She should let the breasts air-dry to prevent them from cracking. Breast-feeding mothers should increase their fluid intake to 2½ to 3 qt (2,500 to 3,000 ml) daily. After feeding an infant with a cleft lip or palate, the nurse should rinse the infant’s mouth with sterile water. The nurse instills erythromycin in a neonate’s eyes primarily to prevent blindness caused by gonorrhea or chlamydia. Human immunodeficiency virus (HIV) has been cultured in breast milk and can be transmitted by an HIV-positive mother who breast-feeds her infant. A fever in the first 24 hours postpartum is most likely caused by dehydration rather than infection. Preterm neonates or neonates who can’t maintain a skin temperature of at least 97.6° F (36.4° C) should receive care in an incubator (Isolette) or a radiant warmer. In a radiant
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warmer, a heat-sensitive probe taped to the neonate’s skin activates the heater unit automatically to maintain the desired temperature. During labor, the resting phase between contractions is at least 30 seconds. Lochia rubra is the vaginal discharge of almost pure blood that occurs during the first few days after childbirth. Lochia serosa is the serous vaginal discharge that occurs 4 to 7 days after childbirth. Lochia alba is the vaginal discharge of decreased blood and increased leukocytes that’s the final stage of lochia. It occurs 7 to 10 days after childbirth. Colostrum, the precursor of milk, is the first secretion from the breasts after delivery. The length of the uterus increases from 2½" (6.3 cm) before pregnancy to 12½" (32 cm) at term. To estimate the true conjugate (the smallest inlet measurement of the pelvis), deduct 1.5 cm from the diagonal conjugate (usually 12 cm). A true conjugate of 10.5 cm enables the fetal head (usually 10 cm) to pass. The smallest outlet measurement of the pelvis is the intertuberous diameter, which is the transverse diameter between the ischial tuberosities. Electronic fetal monitoring is used to assess fetal well-being during labor. If compromised fetal status is suspected, fetal blood pH may be evaluated by obtaining a scalp sample. In an emergency delivery, enough pressure should be applied to the emerging fetus’s head to guide the descent and prevent a rapid change in pressure within the molded fetal skull. After delivery, a multiparous woman is more susceptible to bleeding than a primiparous woman because her uterine muscles may be overstretched and may not contract efficiently. Neonates who are delivered by cesarean birth have a higher incidence of respiratory distress syndrome. The nurse should suggest ambulation to a postpartum patient who has gas pain and flatulence. Massaging the uterus helps to stimulate contractions after the placenta is delivered. When providing phototherapy to a neonate, the nurse should cover the neonate’s eyes and genital area. The narcotic antagonist naloxone (Narcan) may be given to a neonate to correct respiratory depression caused by narcotic administration to the mother during labor. In a neonate, symptoms of respiratory distress syndrome include expiratory grunting or whining, sandpaper breath sounds, and seesaw retractions. Cerebral palsy presents as asymmetrical movement, irritability, and excessive, feeble crying in a long, thin infant.
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The nurse should assess a breech-birth neonate for hydrocephalus, hematomas, fractures, and other anomalies caused by birth trauma. When a patient is admitted to the unit in active labor, the nurse’s first action is to listen for fetal heart tones. In a neonate, long, brittle fingernails are a sign of postmaturity. Desquamation (skin peeling) is common in postmature neonates. A mother should allow her infant to breastfeed until the infant is satisfied. The time may vary from 5 to 20 minutes. Nitrazine paper is used to test the pH of vaginal discharge to determine the presence of amniotic fluid. A pregnant patient normally gains 2 to 5 lb (1 to 2.5 kg) during the first trimester and slightly less than 1 lb (0.5 kg) per week during the last two trimesters. Neonatal jaundice in the first 24 hours after birth is known as pathological jaundice and is a sign of erythroblastosis fetalis. A classic difference between abruptio placentae and placenta previa is the degree of pain. Abruptio placentae causes pain, whereas placenta previa causes painless bleeding. Because a major role of the placenta is to function as a fetal lung, any condition that interrupts normal blood flow to or from the placenta increases fetal partial pressure of arterial carbon dioxide and decreases fetal pH. Precipitate labor lasts for approximately 3 hours and ends with delivery of the neonate. Methylergonovine (Methergine) is an oxytocic agent used to prevent and treat postpartum hemorrhage caused by uterine atony or subinvolution. As emergency treatment for excessive uterine bleeding, 0.2 mg of methylergonovine (Methergine) is injected I.V. over 1 minute while the patient’s blood pressure and uterine contractions are monitored. Braxton Hicks contractions are usually felt in the abdomen and don’t cause cervical change. True labor contractions are felt in the front of the abdomen and back and lead to progressive cervical dilation and effacement The average birth weight of neonates born to mothers who smoke is 6 oz (170 g) less than that of neonates born to nonsmoking mothers. Culdoscopy is visualization of the pelvic organs through the posterior vaginal fornix. The nurse should teach a pregnant vegetarian to obtain protein from alternative sources, such as nuts, soybeans, and legumes. The nurse should instruct a pregnant patient to take only prescribed prenatal vitamins because over-the-counter high-potency vitamins may harm the fetus. High-sodium foods can cause fluid retention, especially in pregnant patients. A pregnant patient can avoid constipation and hemorrhoids by adding fiber to her diet.
➢ If a fetus has late decelerations (a sign of fetal
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hypoxia), the nurse should instruct the mother to lie on her left side and then administer 8 to 10 L of oxygen per minute by mask or cannula. The nurse should notify the physician. The side-lying position removes pressure on the inferior vena cava. Oxytocin (Pitocin) promotes lactation and uterine contractions. Lanugo covers the fetus’s body until about 20 weeks’ gestation. Then it begins to disappear from the face, trunk, arms, and legs, in that order. In a neonate, hypoglycemia causes temperature instability, hypotonia, jitteriness, and seizures. Premature, postmature, smallfor-gestational-age, and large-for-gestationalage neonates are susceptible to this disorder. Neonates typically need to consume 50 to 55 cal per pound of body weight daily. Because oxytocin (Pitocin) stimulates powerful uterine contractions during labor, it must be administered under close observation to help prevent maternal and fetal distress. During fetal heart rate monitoring, variable decelerations indicate compression or prolapse of the umbilical cord. Cytomegalovirus is the leading cause of congenital viral infection. Tocolytic therapy is indicated in premature labor, but contraindicated in fetal death, fetal distress, or severe hemorrhage. Through ultrasonography, the biophysical profile assesses fetal well-being by measuring fetal breathing movements, gross body movements, fetal tone, reactive fetal heart rate (nonstress test), and qualitative amniotic fluid volume. A neonate whose mother has diabetes should be assessed for hyperinsulinism. In a patient with preeclampsia, epigastric pain is a late symptom and requires immediate medical intervention. After a stillbirth, the mother should be allowed to hold the neonate to help her come to terms with the death. Molding is the process by which the fetal head changes shape to facilitate movement through the birth canal. If a woman receives a spinal block before delivery, the nurse should monitor the patient’s blood pressure closely. 5 If a woman suddenly becomes hypotensive during labor, the nurse should increase the infusion rate of I.V. fluids as prescribed. The best technique for assessing jaundice in a neonate is to blanch the tip of the nose or the area just above the umbilicus. During fetal heart monitoring, early deceleration is caused by compression of the head during labor. After the placenta is delivered, the nurse may add oxytocin (Pitocin) to the patient’s I.V. solution, as prescribed, to promote postpartum
involution of the uterus and stimulate lactation. ➢ Pica is a craving to eat nonfood items, such as dirt, crayons, chalk, glue, starch, or hair. It may occur during pregnancy and can endanger the fetus. ➢ A pregnant patient should take folic acid because this nutrient is required for rapid cell division. ➢ A woman who is taking clomiphene (Clomid) to induce ovulation should be informed of the possibility of multiple births with this drug. ➢ If needed, cervical suturing is usually done between 14 and 18 weeks’ gestation to reinforce an incompetent cervix and maintain pregnancy. The suturing is typically removed by 35 weeks’ gestation. ➢ During the first trimester, a pregnant woman should avoid all drugs unless doing so would adversely affect her health. ➢ Most drugs that a breast-feeding mother takes appear in breast milk. ➢ The Food and Drug Administration has established the following five categories of drugs based on their potential for causing birth defects: A, no evidence of risk; B, no risk found in animals, but no studies have been done in women; C, animal studies have shown an adverse effect, but the drug may be beneficial to women despite the potential risk; D, evidence of risk, but its benefits may outweigh its risks; and X, fetal anomalies noted, and the risks clearly outweigh the potential benefits. ➢ A patient with a ruptured ectopic pregnancy commonly has sharp pain in the lower abdomen, with spotting and cramping. She may have abdominal rigidity; rapid, shallow respirations; tachycardia; and shock. ➢ A patient with a ruptured ectopic pregnancy commonly has sharp pain in the lower abdomen, with spotting and cramping. She may have abdominal rigidity; rapid, shallow respirations; tachycardia; and shock. ➢ The mechanics of delivery are engagement, descent and flexion, internal rotation, extension, external rotation, restitution, and expulsion. ➢ A probable sign of pregnancy, McDonald’s sign is characterized by an ease in flexing the body of the uterus against the cervix. ➢ Amenorrhea is a probable sign of pregnancy. ➢ A pregnant woman’s partner should avoid introducing air into the vagina during oral sex because of the possibility of air embolism. ➢ The presence of human chorionic gonadotropin in the blood or urine is a probable sign of pregnancy. ➢ Radiography isn’t usually used in a pregnant woman because it may harm the developing fetus. If radiography is essential, it should be performed only after 36 weeks’ gestation. ➢ A pregnant patient who has had rupture of the membranes or who is experiencing vaginal bleeding shouldn’t engage in sexual intercourse.
➢ Milia may occur as pinpoint spots over a ➢
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neonate’s nose. The duration of a contraction is timed from the moment that the uterine muscle begins to tense to the moment that it reaches full relaxation. It’s measured in seconds. The union of a male and a female gamete produces a zygote, which divides into the fertilized ovum. The first menstrual flow is called menarche and may be anovulatory (infertile). Spermatozoa (or their fragments) remain in the vagina for 72 hours after sexual intercourse. Prolactin stimulates and sustains milk production. Strabismus is a normal finding in a neonate. A postpartum patient may resume sexual intercourse after the perineal or uterine wounds heal (usually within 4 weeks after delivery). A pregnant staff member shouldn’t be assigned to work with a patient who has cytomegalovirus infection because the virus can be transmitted to the fetus. Fetal demise is death of the fetus after viability. Respiratory distress syndrome develops in premature neonates because their alveoli lack surfactant. The most common method of inducing labor after artificial rupture of the membranes is oxytocin (Pitocin) infusion. After the amniotic membranes rupture, the initial nursing action is to assess the fetal heart rate. The most common reasons for cesarean birth are malpresentation, fetal distress, cephalopelvic disproportion, pregnancyinduced hypertension, previous cesarean birth, and inadequate progress in labor. Amniocentesis increases the risk of spontaneous abortion, trauma to the fetus or placenta, premature labor, infection, and Rh sensitization of the fetus. After amniocentesis, abdominal cramping or spontaneous vaginal bleeding may indicate complications. To prevent her from developing Rh antibodies, an Rh-negative primigravida should receive Rho(D) immune globulin (RhoGAM) after delivering an Rh-positive neonate. If a pregnant patient’s test results are negative for glucose but positive for acetone, the nurse should assess the patient’s diet for inadequate caloric intake. If a pregnant patient’s test results are negative for glucose but positive for acetone, the nurse should assess the patient’s diet for inadequate caloric intake. Rubella infection in a pregnant patient, especially during the first trimester, can lead to spontaneous abortion or stillbirth as well as fetal cardiac and other birth defects.
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A pregnant patient should take an iron supplement to help prevent anemia. Direct antiglobulin (direct Coombs’) test is used to detect maternal antibodies attached to red blood cells in the neonate. Nausea and vomiting during the first trimester of pregnancy are caused by rising levels of the hormone human chorionic gonadotropin. Before discharging a patient who has had an abortion, the nurse should instruct her to report bright red clots, bleeding that lasts longer than 7 days, or signs of infection, such as a temperature of greater than 100° F (37.8° C), foul-smelling vaginal discharge, severe uterine cramping, nausea, or vomiting. When informed that a patient’s amniotic membrane has broken, the nurse should check fetal heart tones and then maternal vital signs. The duration of pregnancy averages 280 days, 40 weeks, 9 calendar months, or 10 lunar months. The initial weight loss for a healthy neonate is 5% to 10% of birth weight. The normal hemoglobin value in neonates is 17 to 20 g/dl. Crowning is the appearance of the fetus’s head when its largest diameter is encircled by the vulvovaginal ring. A multipara is a woman who has had two or more pregnancies that progressed to viability, regardless of whether the offspring were alive at birth. In a pregnant patient, preeclampsia may progress to eclampsia, which is characterized by seizures and may lead to coma. The Apgar score is used to assess the neonate’s vital functions. It’s obtained at 1 minute and 5 minutes after delivery. The score is based on respiratory effort, heart rate, muscle tone, reflex irritability, and color. Because of the anti-insulin effects of placental hormones, insulin requirements increase during the third trimester. Gestational age can be estimated by ultrasound measurement of maternal abdominal circumference, fetal femur length, and fetal head size. These measurements are most accurate between 12 and 18 weeks’ gestation. Skeletal system abnormalities and ventricular septal defects are the most common disorders of infants who are born to diabetic women. The incidence of congenital malformation is three times higher in these infants than in those born to nondiabetic women. Skeletal system abnormalities and ventricular septal defects are the most common disorders of infants who are born to diabetic women. The incidence of congenital malformation is three times higher in these infants than in those born to nondiabetic women. The patient with preeclampsia usually has puffiness around the eyes or edema in the hands (for example, “I can’t put my wedding ring on.”).
➢ Kegel exercises require contraction and
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relaxation of the perineal muscles. These exercises help strengthen pelvic muscles and improve urine control in postpartum patients. Symptoms of postpartum depression range from mild postpartum blues to intense, suicidal, depressive psychosis. The preterm neonate may require gavage feedings because of a weak sucking reflex, uncoordinated sucking, or respiratory distress. Acrocyanosis (blueness and coolness of the arms and legs) is normal in neonates because of their immature peripheral circulatory system. To prevent ophthalmia neonatorum (a severe eye infection caused by maternal gonorrhea), the nurse may administer one of three drugs, as prescribed, in the neonate’s eyes: tetracycline, silver nitrate, or erythromycin. Neonatal testing for phenylketonuria is mandatory in most states. The nurse should place the neonate in a 30degree Trendelenburg position to facilitate mucus drainage. The nurse may suction the neonate’s nose and mouth as needed with a bulb syringe or suction trap. To prevent heat loss, the nurse should place the neonate under a radiant warmer during suctioning and initial delivery-room care, and then wrap the neonate in a warmed blanket for transport to the nursery. The umbilical cord normally has two arteries and one vein. When providing care, the nurse should expose only one part of an infant’s body at a time. Lightening is settling of the fetal head into the brim of the pelvis. If the neonate is stable, the mother should be allowed to breast-feed within the neonate’s first hour of life. The nurse should check the neonate’s temperature every 1 to 2 hours until it’s maintained within normal limits. At birth, a neonate normally weighs 5 to 9 lb (2 to 4 kg), measures 18" to 22" (45.5 to 56 cm) in length, has a head circumference of 13½" to 14" (34 to 35.5 cm), and has a chest circumference that’s 1" (2.5 cm) less than the head circumference. In the neonate, temperature normally ranges from 98° to 99° F (36.7° to 37.2° C), apical pulse rate averages 120 to 160 beats/minute, and respirations are 40 to 60 breaths/minute. The diamond-shaped anterior fontanel usually closes between ages 12 and 18 months. The triangular posterior fontanel usually closes by age 2 months. In the neonate, a straight spine is normal. A tuft of hair over the spine is an abnormal finding. Prostaglandin gel may be applied to the vagina or cervix to ripen an unfavorable cervix before labor induction with oxytocin (Pitocin).
➢ Supernumerary nipples are occasionally seen
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on neonates. They usually appear along a line that runs from each axilla, through the normal nipple area, and to the groin. Meconium is a material that collects in the fetus’s intestines and forms the neonate’s first feces, which are black and tarry. The presence of meconium in the amniotic fluid during labor indicates possible fetal distress and the need to evaluate the neonate for meconium aspiration. To assess a neonate’s rooting reflex, the nurse touches a finger to the cheek or the corner of the mouth. Normally, the neonate turns his head toward the stimulus, opens his mouth, and searches for the stimulus. Harlequin sign is present when a neonate who is lying on his side appears red on the dependent side and pale on the upper side. Mongolian spots can range from brown to blue. Their color depends on how close melanocytes are to the surface of the skin. They most commonly appear as patches across the sacrum, buttocks, and legs. Mongolian spots are common in non-white infants and usually disappear by age 2 to 3 years. Vernix caseosa is a cheeselike substance that covers and protects the fetus’s skin in utero. It may be rubbed into the neonate’s skin or washed away in one or two baths. Caput succedaneum is edema that develops in and under the fetal scalp during labor and delivery. It resolves spontaneously and presents no danger to the neonate. The edema doesn’t cross the suture line. Nevus flammeus, or port-wine stain, is a diffuse pink to dark bluish red lesion on a neonate’s face or neck. The Guthrie test (a screening test for phenylketonuria) is most reliable if it’s done between the second and sixth days after birth and is performed after the neonate has ingested protein. To assess coordination of sucking and swallowing, the nurse should observe the neonate’s first breast-feeding or sterile water bottle-feeding. To establish a milk supply pattern, the mother should breast-feed her infant at least every 4 hours. During the first month, she should breast-feed 8 to 12 times daily (demand feeding). To avoid contact with blood and other body fluids, the nurse should wear gloves when handling the neonate until after the first bath is given. If a breast-fed infant is content, has good skin turgor, an adequate number of wet diapers, and normal weight gain, the mother’s milk supply is assumed to be adequate. In the supine position, a pregnant patient’s enlarged uterus impairs venous return from the lower half of the body to the heart,
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resulting in supine hypotensive syndrome, or inferior vena cava syndrome. Tocolytic agents used to treat preterm labor include terbutaline (Brethine), ritodrine (Yutopar), and magnesium sulfate. A pregnant woman who has hyperemesis gravidarum may require hospitalization to treat dehydration and starvation. Diaphragmatic hernia is one of the most urgent neonatal surgical emergencies. By compressing and displacing the lungs and heart, this disorder can cause respiratory distress shortly after birth. Common complications of early pregnancy (up to 20 weeks’ gestation) include fetal loss and serious threats to maternal health. Fetal embodiment is a maternal developmental task that occurs in the second trimester. During this stage, the mother may complain that she never gets to sleep because the fetus always gives her a thump when she tries. Visualization in pregnancy is a process in which the mother imagines what the child she’s carrying is like and becomes acquainted with it. 7 Hemodilution of pregnancy is the increase in blood volume that occurs during pregnancy. The increased volume consists of plasma and causes an imbalance between the ratio of red blood cells to plasma and a resultant decrease in hematocrit. Mean arterial pressure of greater than 100 mm Hg after 20 weeks of pregnancy is considered hypertension. The treatment for supine hypotension syndrome (a condition that sometimes occurs in pregnancy) is to have the patient lie on her left side. A contributing factor in dependent edema in the pregnant patient is the increase of femoral venous pressure from 10 mm Hg (normal) to 18 mm Hg (high). Hyperpigmentation of the pregnant patient’s face, formerly called chloasma and now referred to as melasma, fades after delivery. The hormone relaxin, which is secreted first by the corpus luteum and later by the placenta, relaxes the connective tissue and cartilage of the symphysis pubis and the sacroiliac joint to facilitate passage of the fetus during delivery. Progesterone maintains the integrity of the pregnancy by inhibiting uterine motility. Ladin’s sign, an early indication of pregnancy, causes softening of a spot on the anterior portion of the uterus, just above the uterocervical juncture. During pregnancy, the abdominal line from the symphysis pubis to the umbilicus changes from linea alba to linea nigra. In neonates, cold stress affects the circulatory, regulatory, and respiratory systems. Obstetric data can be described by using the F/TPAL system: F/T: Full-term delivery at 38 weeks or longer
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P: Preterm delivery between 20 and 37 weeks A: Abortion or loss of fetus before 20 weeks L: Number of children living (if a child has died, further explanation is needed to clarify the discrepancy in numbers). Parity doesn’t refer to the number of infants delivered, only the number of deliveries. Women who are carrying more than one fetus should be encouraged to gain 35 to 45 lb (15.5 to 20.5 kg) during pregnancy. The recommended amount of iron supplement for the pregnant patient is 30 to 60 mg daily. Drinking six alcoholic beverages a day or a single episode of binge drinking in the first trimester can cause fetal alcohol syndrome. Chorionic villus sampling is performed at 8 to 12 weeks of pregnancy for early identification of genetic defects. In percutaneous umbilical blood sampling, a blood sample is obtained from the umbilical cord to detect anemia, genetic defects, and blood incompatibility as well as to assess the need for blood transfusions. The period between contractions is referred to as the interval, or resting phase. During this phase, the uterus and placenta fill with blood and allow for the exchange of oxygen, carbon dioxide, and nutrients. In a patient who has hypertonic contractions, the uterus doesn’t have an opportunity to relax and there is no interval between contractions. As a result, the fetus may experience hypoxia or rapid delivery may occur. Two qualities of the myometrium are elasticity, which allows it to stretch yet maintain its tone, and contractility, which allows it to shorten and lengthen in a synchronized pattern. During crowning, the presenting part of the fetus remains visible during the interval between contractions. Uterine atony is failure of the uterus to remain firmly contracted. The major cause of uterine atony is a full bladder. If the mother wishes to breast-feed, the neonate should be nursed as soon as possible after delivery. A smacking sound, milk dripping from the side of the mouth, and sucking noises all indicate improper placement of the infant’s mouth over the nipple. Before feeding is initiated, an infant should be burped to expel air from the stomach. Most authorities strongly encourage the continuation of breast-feeding on both the affected and the unaffected breast of patients with mastitis. Neonates are nearsighted and focus on items that are held 10" to 12" (25 to 30.5 cm) away. In a neonate, low-set ears are associated with chromosomal abnormalities such as Down syndrome.
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hours; however, passage may take up to 72 hours. Boys who are born with hypospadias shouldn’t be circumcised at birth because the foreskin may be needed for constructive surgery. In the neonate, the normal blood glucose level is 45 to 90 mg/dl. Hepatitis B vaccine is usually given within 48 hours of birth. Hepatitis B immune globulin is usually given within 12 hours of birth. HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome is an unusual variation of pregnancy-induced hypertension. Maternal serum alpha-fetoprotein is detectable at 7 weeks of gestation and peaks in the third trimester. High levels detected between the 16th and 18th weeks are associated with neural tube defects. Low levels are associated with Down syndrome. An arrest of descent occurs when the fetus doesn’t descend through the pelvic cavity during labor. It’s commonly associated with cephalopelvic disproportion, and cesarean delivery may be required. A late sign of preeclampsia is epigastric pain as a result of severe liver edema. In the patient with preeclampsia, blood pressure returns to normal during the puerperal period. To obtain an estriol level, urine is collected for 24 hours. An estriol level is used to assess fetal wellbeing and maternal renal functioning as well as to monitor a pregnancy that’s complicated by diabetes. A pregnant patient with vaginal bleeding shouldn’t have a pelvic examination. In the early stages of pregnancy, the finding of glucose in the urine may be related to the increased shunting of glucose to the developing placenta, without a corresponding increase in the reabsorption capability of the kidneys. A patient who has premature rupture of the membranes is at significant risk for infection if labor doesn’t begin within 24 hours. Infants of diabetic mothers are susceptible to macrosomia as a result of increased insulin production in the fetus. To prevent heat loss in the neonate, the nurse should bathe one part of his body at a time and keep the rest of the body covered. A patient who has a cesarean delivery is at greater risk for infection than the patient who gives birth vaginally. The occurrence of thrush in the neonate is probably caused by contact with the organism during delivery through the birth canal. The nurse should keep the sac of meningomyelocele moist with normal saline solution. If fundal height is at least 2 cm less than expected, the cause may be growth
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retardation, missed abortion, transverse lie, or false pregnancy. Fundal height that exceeds expectations by more than 2 cm may be caused by multiple gestation, polyhydramnios, uterine myomata, or a large baby. A major developmental task for a woman during the first trimester of pregnancy is accepting the pregnancy. Unlike formula, breast milk offers the benefit of maternal antibodies. Spontaneous rupture of the membranes increases the risk of a prolapsed umbilical cord. A clinical manifestation of a prolapsed umbilical cord is variable decelerations. During labor, to relieve supine hypotension manifested by nausea and vomiting and paleness, turn the patient on her left side. If the ovum is fertilized by a spermatozoon carrying a Y chromosome, a male zygote is formed. Implantation occurs when the cellular walls of the blastocyte implants itself in the endometrium, usually 7 to 9 days after fertilization. Implantation occurs when the cellular walls of the blastocyte implants itself in the endometrium, usually 7 to 9 days after fertilization. Heart development in the embryo begins at 2 to 4 weeks and is complete by the end of the embryonic stage. Methergine stimulates uterine contractions. The administration of folic acid during the early stages of gestation may prevent neural tube defects. With advanced maternal age, a common genetic problem is Down syndrome. With early maternal age, cephalopelvic disproportion commonly occurs. In the early postpartum period, the fundus should be midline at the umbilicus. A rubella vaccine shouldn’t be given to a pregnant woman. The vaccine can be administered after delivery, but the patient should be instructed to avoid becoming pregnant for 3 months. A 16-year-old girl who is pregnant is at risk for having a low-birth-weight neonate. The mother’s Rh factor should be determined before an amniocentesis is performed. Maternal hypotension is a complication of spinal block. After delivery, if the fundus is boggy and deviated to the right side, the patient should empty her bladder. Before providing a specimen for a sperm count, the patient should avoid ejaculation for 48 to 72 hours. The hormone human chorionic gonadotropin is a marker for pregnancy. Painless vaginal bleeding during the last trimester of pregnancy may indicate placenta previa.
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During the transition phase of labor, the woman usually is irritable and restless. Because women with diabetes have a higher incidence of birth anomalies than women without diabetes, an alpha-fetoprotein level may be ordered at 15 to 17 weeks’ gestation. To avoid puncturing the placenta, a vaginal examination shouldn’t be performed on a pregnant patient who is bleeding. A patient who has postpartum hemorrhage caused by uterine atony should be given oxytocin as prescribed. Laceration of the vagina, cervix, or perineum produces bright red bleeding that often comes in spurts. The bleeding is continuous, even when the fundus is firm. Hot compresses can help to relieve breast tenderness after breast-feeding. The fundus of a postpartum patient is massaged to stimulate contraction of the uterus and prevent hemorrhage. A mother who has a positive human immunodeficiency virus test result shouldn’t breast-feed her infant. Dinoprostone (Cervidil) is used to ripen the cervix. Breast-feeding of a premature neonate born at 32 weeks’ gestation can be accomplished if the mother expresses milk and feeds the neonate by gavage. If a pregnant patient’s rubella titer is less than 1:8, she should be immunized after delivery. The administration of oxytocin (Pitocin) is stopped if the contractions are 90 seconds or longer. For an extramural delivery (one that takes place outside of a normal delivery center), the priorities for care of the neonate include maintaining a patent airway, supporting efforts to breathe, monitoring vital signs, and maintaining adequate body temperature. Subinvolution may occur if the bladder is distended after delivery. The nurse must place identification bands on both the mother and the neonate before they leave the delivery room. Erythromycin is given at birth to prevent ophthalmia neonatorum. Pelvic-tilt exercises can help to prevent or relieve backache during pregnancy. Before performing a Leopold maneuver, the nurse should ask the patient to empty her bladder. Psychiatric nursing bullets review 9 According to Kübler-Ross, the five stages of death and dying are denial, anger, bargaining, depression, and acceptance. Flight of ideas is an alteration in thought processes that’s characterized by skipping from one topic to another, unrelated topic. La belle indifférence is the lack of concern for a profound disability, such as blindness or paralysis that may occur in a patient who has a conversion disorder.
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Moderate anxiety decreases a person’s ability to perceive and concentrate. The person is selectively inattentive (focuses on immediate concerns), and the perceptual field narrows. A patient who has a phobic disorder uses selfprotective avoidance as an ego defense mechanism. In a patient who has anorexia nervosa, the highest treatment priority is correction of nutritional and electrolyte imbalances. A patient who is taking lithium must undergo regular (usually once a month) monitoring of the blood lithium level because the margin between therapeutic and toxic levels is narrow. A normal laboratory value is 0.5 to 1.5 mEq/L. Early signs and symptoms of alcohol withdrawal include anxiety, anorexia, tremors, and insomnia. They may begin up to 8 hours after the last alcohol intake. Al-Anon is a support group for families of alcoholics. The nurse shouldn’t administer chlorpromazine (Thorazine) to a patient who has ingested alcohol because it may cause oversedation and respiratory depression. Lithium toxicity can occur when sodium and fluid intake are insufficient, causing lithium retention. An alcoholic who achieves sobriety is called a recovering alcoholic because no cure for alcoholism exists. According to Erikson, the school-age child (ages 6 to 12) is in the industry-versusinferiority stage of psychosocial development. When caring for a depressed patient, the nurse’s first priority is safety because of the increased risk of suicide. Echolalia is parrotlike repetition of another person’s words or phrases. According to psychoanalytic theory, the ego is the part of the psyche that controls internal demands and interacts with the outside world at the conscious, preconscious, and unconscious levels. According to psychoanalytic theory, the superego is the part of the psyche that’s composed of morals, values, and ethics. It continually evaluates thoughts and actions, rewarding the good and punishing the bad. (Think of the superego as the “supercop” of the unconscious.) According to psychoanalytic theory, the id is the part of the psyche that contains instinctual drives. (Remember i for instinctual and d for drive.) Denial is the defense mechanism used by a patient who denies the reality of an event. In a psychiatric setting, seclusion is used to reduce overwhelming environmental stimulation, protect the patient from self-injury or injury to others, and prevent damage to hospital property. It’s used for patients who don’t respond to less restrictive interventions. Seclusion controls external behavior until the
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patient can assume self-control and helps the patient to regain self-control. Tyramine-rich food, such as aged cheese, chicken liver, avocados, bananas, meat tenderizer, salami, bologna, Chianti wine, and beer may cause severe hypertension in a patient who takes a monoamine oxidase inhibitor. A patient who takes a monoamine oxidase inhibitor should be weighed biweekly and monitored for suicidal tendencies. If the patient who takes a monoamine oxidase inhibitor has palpitations, headaches, or severe orthostatic hypotension, the nurse should withhold the drug and notify the physician. Common causes of child abuse are poor impulse control by the parents and the lack of knowledge of growth and development. The diagnosis of Alzheimer’s disease is based on clinical findings of two or more cognitive deficits, progressive worsening of memory, and the results of a neuropsychological test. Memory disturbance is a classic sign of Alzheimer’s disease. Thought blocking is loss of the train of thought because of a defect in mental processing. A compulsion is an irresistible urge to perform an irrational act, such as walking in a clockwise circle before leaving a room or washing the hands repeatedly. A patient who has a chosen method and a plan to commit suicide in the next 48 to 72 hours is at high risk for suicide. The therapeutic serum level for lithium is 0.5 to 1.5 mEq/L. Phobic disorders are treated with desensitization therapy, which gradually exposes a patient to an anxiety-producing stimulus. Dysfunctional grieving is absent or prolonged grief. During phase I of the nurse-patient relationship (beginning, or orientation, phase), the nurse obtains an initial history and the nurse and the patient agree to a contract. During phase II of the nurse-patient relationship (middle, or working, phase), the patient discusses his problems, behavioral changes occur, and self-defeating behavior is resolved or reduced. During phase III of the nurse-patient relationship (termination, or resolution, phase), the nurse terminates the therapeutic relationship and gives the patient positive feedback on his accomplishments. According to Freud, a person between ages 12 and 20 is in the genital stage, during which he learns independence, has an increased interest in members of the opposite sex, and establishes an identity. According to Erikson, the identity-versus-role confusion stage occurs between ages 12 and 20.
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Tolerance is the need for increasing amounts of a substance to achieve an effect that formerly was achieved with lesser amounts. Suicide is the third leading cause of death among white teenagers. Most teenagers who kill themselves made a previous suicide attempt and left telltale signs of their plans. In Erikson’s stage of generativity versus despair, generativity (investment of the self in the interest of the larger community) is expressed through procreation, work, community service, and creative endeavors. Alcoholics Anonymous recommends a 12-step program to achieve sobriety. Signs and symptoms of anorexia nervosa include amenorrhea, excessive weight loss, lanugo (fine body hair), abdominal distention, and electrolyte disturbances. A serum lithium level that exceeds 2.0 mEq/L is considered toxic. Public Law 94-247 (Child Abuse and Neglect Act of 1973) requires reporting of suspected cases of child abuse to child protection services. The nurse should suspect sexual abuse in a young child who has blood in the feces or urine, penile or vaginal discharge, genital trauma that isn’t readily explained, or a sexually transmitted disease. An alcoholic uses alcohol to cope with the stresses of life. The human personality operates on three levels: conscious, preconscious, and unconscious. Asking a patient an open-ended question is one of the best ways to elicit or clarify information. The diagnosis of autism is often made when a child is between ages 2 and 3. Defense mechanisms protect the personality by reducing stress and anxiety. Suppression is voluntary exclusion of stressproducing thoughts from the consciousness. In psychodrama, life situations are approximated in a structured environment, allowing the participant to recreate and enact scenes to gain insight and to practice new skills. Psychodrama is a therapeutic technique that’s used with groups to help participants gain new perception and self-awareness by acting out their own or assigned problems. A patient who is taking disulfiram (Antabuse) must avoid ingesting products that contain alcohol, such as cough syrup, fruitcake, and sauces and soups made with cooking wine. A patient who is admitted to a psychiatric hospital involuntarily loses the right to sign out against medical advice. “People who live in glass houses shouldn’t throw stones” and “A rolling stone gathers no moss” are examples of proverbs used during a psychiatric interview to determine a patient’s ability to think abstractly. (Schizophrenic
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patients think in concrete terms and might interpret the glass house proverb as “If you throw a stone in a glass house, the house will break.”) Signs of lithium toxicity include diarrhea, tremors, nausea, muscle weakness, ataxia, and confusion. A labile affect is characterized by rapid shifts of emotions and mood. Amnesia is loss of memory from an organic or inorganic cause. A person who has borderline personality disorder is demanding and judgmental in interpersonal relationships and will attempt to split staff by pointing to discrepancies in the treatment plan. Disulfiram (Antabuse) shouldn’t be taken concurrently with metronidazole (Flagyl) because they may interact and cause a psychotic reaction. In rare cases, electroconvulsive therapy causes arrhythmias and death. A patient who is scheduled for electroconvulsive therapy should receive nothing by mouth after midnight to prevent aspiration while under anesthesia. Electroconvulsive therapy is normally used for patients who have severe depression that doesn’t respond to drug therapy. For electroconvulsive therapy to be effective, the patient usually receives 6 to 12 treatments at a rate of 2 to 3 per week. During the manic phase of bipolar affective disorder, nursing care is directed at slowing the patient down because the patient may die as a result of self-induced exhaustion or injury. For a patient with Alzheimer’s disease, the nursing care plan should focus on safety measures. After sexual assault, the patient’s needs are the primary concern, followed by medicolegal considerations. Patients who are in a maintenance program for narcotic abstinence syndrome receive 10 to 40 mg of methadone (Dolophine) in a single daily dose and are monitored to ensure that the drug is ingested. Stress management is a short-range goal of psychotherapy. The mood most often experienced by a patient with organic brain syndrome is irritability. Creative intuition is controlled by the right side of the brain. Methohexital (Brevital) is the general anesthetic that’s administered to patients who are scheduled for electroconvulsive therapy. The decision to use restraints should be based on the patient’s safety needs. Diphenhydramine (Benadryl) relieves the extrapyramidal adverse effects of psychotropic drugs. In a patient who is stabilized on lithium (Eskalith) therapy, blood lithium levels should be checked 8 to 12 hours after the first dose, then two or three times weekly during the first
month. Levels should be checked weekly to monthly during maintenance therapy. ➢ The primary purpose of psychotropic drugs is to decrease the patient’s symptoms, which improves function and increases compliance with therapy. ➢ Manipulation is a maladaptive method of meeting one’s needs because it disregards the needs and feelings of others. ➢ If a patient has symptoms of lithium toxicity, the nurse should withhold one dose and call the physician. ➢ A patient who is taking lithium (Eskalith) for bipolar affective disorder must maintain a balanced diet with adequate salt intake. ➢ A patient who constantly seeks approval or assistance from staff members and other patients is demonstrating dependent behavior. ➢ Alcoholics Anonymous advocates total abstinence from alcohol. ➢ Methylphenidate (Ritalin) is the drug of choice for treating attention deficit hyperactivity disorder in children. ➢ Setting limits is the most effective way to control manipulative behavior. ➢ Violent outbursts are common in a patient who has borderline personality disorder. ➢ When working with a depressed patient, the nurse should explore meaningful losses. ➢ An illusion is a misinterpretation of an actual environmental stimulus. ➢ Anxiety is nonspecific; fear is specific. ➢ Extrapyramidal adverse effects are common in patients who take antipsychotic drugs. ➢ The nurse should encourage an angry patient to follow a physical exercise program as one of the ways to ventilate feelings. ➢ Depression is clinically significant if it’s characterized by exaggerated feelings of sadness, melancholy, dejection, worthlessness, and hopelessness that are inappropriate or out of proportion to reality. ➢ Free-floating anxiety is anxiousness with generalized apprehension and pessimism for unknown reasons. ➢ In a patient who is experiencing intense anxiety, the fight-or-flight reaction (alarm reflex) may take over. ➢ Confabulation is the use of imaginary experiences or made-up information to fill missing gaps of memory. ➢ When starting a therapeutic relationship with a patient, the nurse should explain that the purpose of the therapy is to produce a positive change. ➢ A basic assumption of psychoanalytic theory is that all behavior has meaning. ➢ Catharsis is the expression of deep feelings and emotions. ➢ According to the pleasure principle, the psyche seeks pleasure and avoids unpleasant experiences, regardless of the consequences. ➢ A patient who has a conversion disorder resolves a psychological conflict through the loss of a specific physical function (for
example, paralysis, blindness, or inability to swallow). This loss of function is involuntary, but diagnostic tests show no organic cause. ➢ Chlordiazepoxide (Librium) is the drug of choice for treating alcohol withdrawal symptoms. ➢ For a patient who is at risk for alcohol withdrawal, the nurse should assess the pulse rate and blood pressure every 2 hours for the first 12 hours, every 4 hours for the next 24 hours, and every 6 hours thereafter (unless the patient’s condition becomes unstable). ➢ Alcohol detoxification is most successful when carried out in a structured environment by a supportive, nonjudgmental staff. ➢ The nurse should follow these guidelines when caring for a patient who is experiencing alcohol withdrawal: Maintain a calm environment, keep intrusions to a minimum, speak slowly and calmly, adjust lighting to prevent shadows and glare, call the patient by name, and have a friend or family member stay with the patient, if possible. ➢ The therapeutic regimen for an alcoholic patient includes folic acid, thiamine, and multivitamin supplements as well as adequate food and fluids. ➢ A patient who is addicted to opiates (drugs derived from poppy seeds, such as heroin and morphine) typically experiences withdrawal symptoms within 12 hours after the last dose. The most severe symptoms occur within 48 hours and decrease over the next 2 weeks. ➢ Reactive depression is a response to a specific life event. ➢ Projection is the unconscious assigning of a thought, feeling, or action to someone or something else. ➢ Sublimation is the channeling of unacceptable impulses into socially acceptable behavior. ➢ Repression is an unconscious defense mechanism whereby unacceptable or painful thoughts, impulses, memories, or feelings are pushed from the consciousness or forgotten. ➢ Hypochondriasis is morbid anxiety about one’s health associated with various symptoms that aren’t caused by organic disease. ➢ Denial is a refusal to acknowledge feelings, thoughts, desires, impulses, or external facts that are consciously intolerable. ➢ Reaction formation is the avoidance of anxiety through behavior and attitudes that are the opposite of repressed impulses and drives. ➢ Displacement is the transfer of unacceptable feelings to a more acceptable object. ➢ Regression is a retreat to an earlier developmental stage. ➢ According to Erikson, an older adult (age 65 or older) is in the developmental stage of integrity versus despair. ➢ Family therapy focuses on the family as a whole rather than the individual. Its major objective is to reestablish rational communication between family members.
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When caring for a patient who is hostile or angry, the nurse should attempt to remain calm, listen impartially, use short sentences, and speak in a firm, quiet voice. Ritualism and negativism are typical toddler behaviors. They occur during the developmental stage identified by Erikson as autonomy versus shame and doubt. Circumstantiality is a disturbance in associated thought and speech patterns in which a patient gives unnecessary, minute details and digresses into inappropriate thoughts that delay communication of central ideas and goal achievement. Idea of reference is an incorrect belief that the statements or actions of others are related to oneself. Group therapy provides an opportunity for each group member to examine interactions, learn and practice successful interpersonal communication skills, and explore emotional conflicts. Korsakoff’s syndrome is believed to be a chronic form of Wernicke’s encephalopathy. It’s marked by hallucinations, confabulation, amnesia, and disturbances of orientation. 12 A patient with antisocial personality disorder often engages in confrontations with authority figures, such as police, parents, and school officials. A patient with paranoid personality disorder exhibits suspicion, hypervigilance, and hostility toward others. Depression is the most common psychiatric disorder. Adverse reactions to tricyclic antidepressant drugs include tachycardia, orthostatic hypotension, hypomania, lowered seizure threshold, tremors, weight gain, problems with erections or orgasms, and anxiety. The Minnesota Multiphasic Personality Inventory consists of 550 statements for the subject to interpret. It assesses personality and detects disorders, such as depression and schizophrenia, in adolescents and adults. Organic brain syndrome is the most common form of mental illness in elderly patients. A person who has an IQ of less than 20 is profoundly retarded and is considered a totalcare patient. Reframing is a therapeutic technique that’s used to help depressed patients to view a situation in alternative ways. Fluoxetine (Prozac), sertraline (Zoloft), and paroxetine (Paxil) are serotonin reuptake inhibitors used to treat depression. The early stage of Alzheimer’s disease lasts 2 to 4 years. Patients have inappropriate affect, transient paranoia, disorientation to time, memory loss, careless dressing, and impaired judgment. The middle stage of Alzheimer’s disease lasts 4 to 7 years and is marked by profound personality changes, loss of independence,
disorientation, confusion, inability to recognize family members, and nocturnal restlessness. ➢ The last stage of Alzheimer’s disease occurs during the final year of life and is characterized by a blank facial expression, seizures, loss of appetite, emaciation, irritability, and total dependence. ➢ Threatening a patient with an injection for failing to take an oral drug is an example of assault. ➢ Reexamination of life goals is a major developmental task during middle adulthood. ➢ Acute alcohol withdrawal causes anorexia, insomnia, headache, and restlessness and escalates to a syndrome that’s characterized by agitation, disorientation, vivid hallucinations, and tremors of the hands, feet, legs, and tongue. ➢ In a hospitalized alcoholic, alcohol withdrawal delirium most commonly occurs 3 to 4 days after admission. ➢ Confrontation is a communication technique in which the nurse points out discrepancies between the patient’s words and his nonverbal behaviors. ➢ For a patient with substance-induced delirium, the time of drug ingestion can help to determine whether the drug can be evacuated from the body. ➢ Treatment for alcohol withdrawal may include administration of I.V. glucose for hypoglycemia, I.V. fluid containing thiamine and other B vitamins, and antianxiety, antidiarrheal, anticonvulsant, and antiemetic drugs. ➢ The alcoholic patient receives thiamine to help prevent peripheral neuropathy and Korsakoff’s syndrome. ➢ Alcohol withdrawal may precipitate seizure activity because alcohol lowers the seizure threshold in some people. ➢ Paraphrasing is an active listening technique in which the nurse restates what the patient has just said. ➢ A patient with Korsakoff’s syndrome may use confabulation (made up information) to cover memory lapses or periods of amnesia. ➢ People with obsessive-compulsive disorder realize that their behavior is unreasonable, but are powerless to control it. ➢ When witnessing psychiatric patients who are engaged in a threatening confrontation, the nurse should first separate the two individuals. ➢ Patients with anorexia nervosa or bulimia must be observed during meals and for some time afterward to ensure that they don’t purge what they have eaten. ➢ Transsexuals believe that they were born the wrong gender and may seek hormonal or surgical treatment to change their gender. ➢ Fugue is a dissociative state in which a person leaves his familiar surroundings, assumes a new identity, and has amnesia about his previous identity. (It’s also described as “flight from himself.”)
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In a psychiatric setting, the patient should be able to predict the nurse’s behavior and expect consistent positive attitudes and approaches. When establishing a schedule for a one-to-one interaction with a patient, the nurse should state how long the conversation will last and then adhere to the time limit. Thought broadcasting is a type of delusion in which the person believes that his thoughts are being broadcast for the world to hear. Lithium should be taken with food. A patient who is taking lithium shouldn’t restrict his sodium intake. A patient who is taking lithium should stop taking the drug and call his physician if he experiences vomiting, drowsiness, or muscle weakness. The patient who is taking a monoamine oxidase inhibitor for depression can include cottage cheese, cream cheese, yogurt, and sour cream in his diet. Sensory overload is a state in which sensory stimulation exceeds the individual’s capacity to tolerate or process it. Symptoms of sensory overload include a feeling of distress and hyperarousal with impaired thinking and concentration. In sensory deprivation, overall sensory input is decreased. A sign of sensory deprivation is a decrease in stimulation from the environment or from within oneself, such as daydreaming, inactivity, sleeping excessively, and reminiscing. The three stages of general adaptation syndrome are alarm, resistance, and exhaustion. A maladaptive response to stress is drinking alcohol or smoking excessively. 13 Hyperalertness and the startle reflex are characteristics of posttraumatic stress disorder. A treatment for a phobia is desensitization, a process in which the patient is slowly exposed to the feared stimuli. Symptoms of major depressive disorder include depressed mood, inability to experience pleasure, sleep disturbance, appetite changes, decreased libido, and feelings of worthlessness. Clinical signs of lithium toxicity are nausea, vomiting, and lethargy. Asking too many “why” questions yields scant information and may overwhelm a psychiatric patient and lead to stress and withdrawal. Remote memory may be impaired in the late stages of dementia. According to the DSM-IV, bipolar II disorder is characterized by at least one manic episode that’s accompanied by hypomania. The nurse can use silence and active listening to promote interactions with a depressed patient.
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A psychiatric patient with a substance abuse problem and a major psychiatric disorder has a dual diagnosis. When a patient is readmitted to a mental health unit, the nurse should assess compliance with medication orders. Alcohol potentiates the effects of tricyclic antidepressants. Flight of ideas is movement from one topic to another without any discernible connection. Conduct disorder is manifested by extreme behavior, such as hurting people and animals. During the “tension-building” phase of an abusive relationship, the abused individual feels helpless. In the emergency treatment of an alcoholintoxicated patient, determining the bloodalcohol level is paramount in determining the amount of medication that the patient needs. Side effects of the antidepressant fluoxetine (Prozac) include diarrhea, decreased libido, weight loss, and dry mouth. Before electroconvulsive therapy, the patient is given the skeletal muscle relaxant succinylcholine (Anectine) by I.V. administration. When a psychotic patient is admitted to an inpatient facility, the primary concern is safety, followed by the establishment of trust. An effective way to decrease the risk of suicide is to make a suicide contract with the patient for a specified period of time. A depressed patient should be given sufficient portions of his favorite foods, but shouldn’t be overwhelmed with too much food. The nurse should assess the depressed patient for suicidal ideation. Delusional thought patterns commonly occur during the manic phase of bipolar disorder. Apathy is typically observed in patients who have schizophrenia. Manipulative behavior is characteristic of a patient who has passive– aggressive personality disorder. When a patient who has schizophrenia begins to hallucinate, the nurse should redirect the patient to activities that are focused on the here and now. When a patient who is receiving an antipsychotic drug exhibits muscle rigidity and tremors, the nurse should administer an antiparkinsonian drug (for example, Cogentin or Artane) as ordered. A patient who is receiving lithium (Eskalith) therapy should report diarrhea, vomiting, drowsiness, muscular weakness, or lack of coordination to the physician immediately. The therapeutic serum level of lithium (Eskalith) for maintenance is 0.6 to 1.2 mEq/L. Obsessive-compulsive disorder is an anxietyrelated disorder. Al-Anon is a self-help group for families of alcoholics. Desensitization is a treatment for phobia, or irrational fear.
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After electroconvulsive therapy, the patient is placed in the lateral position, with the head turned to one side. A delusion is a fixed false belief. Giving away personal possessions is a sign of suicidal ideation. Other signs include writing a suicide note or talking about suicide. Agoraphobia is fear of open spaces. A person who has paranoid personality disorder projects hostilities onto others. To assess a patient’s judgment, the nurse should ask the patient what he would do if he found a stamped, addressed envelope. An appropriate response is that he would mail the envelope. After electroconvulsive therapy, the patient should be monitored for post-shock amnesia. A mother who continues to perform cardiopulmonary resuscitation after a physician pronounces a child dead is showing denial. Transvestism is a desire to wear clothes usually worn by members of the opposite sex. Tardive dyskinesia causes excessive blinking and unusual movement of the tongue, and involuntary sucking and chewing. Trihexyphenidyl (Artane) and benztropine (Cogentin) are administered to counteract extrapyramidal adverse effects. To prevent hypertensive crisis, a patient who is taking a monoamine oxidase inhibitor should avoid consuming aged cheese, caffeine, beer, yeast, chocolate, liver, processed foods, and monosodium glutamate. Extrapyramidal symptoms include parkinsonism, dystonia, akathisia (“ants in the pants”), and tardive dyskinesia. One theory that supports the use of electroconvulsive therapy suggests that it “resets” the brain circuits to allow normal function. A patient who has obsessive-compulsive disorder usually recognizes the senselessness of his behavior but is powerless to stop it (egodystonia). In helping a patient who has been abused, physical safety is the nurse’s first priority. Pemoline (Cylert) is used to treat attention deficit hyperactivity disorder (ADHD). 14 Clozapine (Clozaril) is contraindicated in pregnant women and in patients who have severe granulocytopenia or severe central nervous system depression. Repression, an unconscious process, is the inability to recall painful or unpleasant thoughts or feelings. Projection is shifting of unwanted characteristics or shortcomings to others (scapegoat). Hypnosis is used to treat psychogenic amnesia. Disulfiram (Antabuse) is administered orally as an aversion therapy to treat alcoholism. Ingestion of alcohol by a patient who is taking disulfiram (Antabuse) can cause severe
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reactions, including nausea and vomiting, and may endanger the patient’s life. Improved concentration is a sign that lithium is taking effect. Behavior modification, including time-outs, token economy, or a reward system, is a treatment for attention deficit hyperactivity disorder. For a patient who has anorexia nervosa, the nurse should provide support at mealtime and record the amount the patient eats. A significant toxic risk associated with clozapine (Clozaril) administration is blood dyscrasia. Adverse effects of haloperidol (Haldol) administration include drowsiness; insomnia; weakness; headache; and extrapyramidal symptoms, such as akathisia, tardive dyskinesia, and dystonia. Hypervigilance and déjà vu are signs of posttraumatic stress disorder (PTSD). A child who shows dissociation has probably been abused. Confabulation is the use of fantasy to fill in gaps of memo COMMUNICABLE DISEASE NURSING COMMUNICABLE DISEASE Infectious Agent or its toxic products - AGENT Directly or Indirectly - MODE OF TRANSMISSION Person, Animal or Intermediate Vector – HOST Environment - ENVIRONMENT ECOLOGIC TRIAD OF DISEASE Agent – element, substance, animate or inanimate that may serve as stimulus to initiate a disease process Host – organism that provides nourishment for another organism Environment – physical (climate), biological (plants & animals) CONTAGIOUS VS. INFECTIOUS Contagious Diseases that are easily spread directly transmitted from person to person (direct contact) through an intermediary host Infectious Diseases that caused by a pathogen not transmitted by ordinary contact but require a direct inoculation through a break in the skin or mucous membrane. NOTE: ALL CONTAGIOUS DISEASE ARE INFECTIOUS BUT INFECTIOUS DISEASE IS NOT ALWAYS CONTAGIOUS What is Infection? INFECTION - "the state or condition in which the body or part of the body is invaded by a pathogenic agent ( bacteria, virus, parasites etc.) which under favorable conditions multiplies and produces effects which are injurious…" Infectious Agent A. RESIDENT ORGANISMS deeply seated in the epidermis, not easily removed by simple handwashing, Ex: Staphylococci
B. TRANSIENT ORGANISM represent recent contamination, survive for a limited period of time, acquired during contact with the infected colonized patient or environment, easily removed by good handwashing Ex: ( Klebsiella & Pseudomonas) Infectious Agent Bacteria – heama organism, systemic Virus – nuero organism, systemic Fungi – skin organism, local Protozoa – GI organism, local Infectious Agent FACTORS THAT AFFECTS THE AGENT TO DEVELOP A DISEASE Pathogenicity – ability to cause a disease Infective dose – no of organism to initiate infection Virulence – ability to enter or move through tissues Specificity – ability of the organism to develop antigens STAGES OF INFECTIOUS PROCESS Means of Transmission 1. CONTACT - most common means of transmitting microorganisms from one person to another. A. Direct Contact (person to person) occurs when one person touches another best vehicle is the Hands especially those of the Health Care workers Indirect Contact (inanimate object) - occurs when a person touches an inanimate object contaminated by an infected patient 2. AIRBORNE - droplet, dust, organisms in env. 3. VECTOR - insects or animals 4. VEHICLE - food (salmonella), water (shigellosis), blood (Hepa B), medication ( contaminated infusion) PREVENTION OF COMMUNICABLE DISEASE Prevention is worth a pound than cure PREVENTION OF COMMUNICABLE DISEASE Health Education – primary role of the nurse Specific Protection- handwashing, use of protective devices Environmental Sanitation – clean and conducive for health Definition of Prevention “Actions aimed at eradicating, eliminating, or minimizing the impact of disease and disability. The concept of prevention is best defined in the context of levels, traditionally called primary, secondary, and tertiary prevention” A Dictionary of Epidemiology, Fourth Edition by John M. Last Prevention of Needlestick Injuries Dispose Used Needles in Puncture Proof Needle Containers Don’t Recap Needles (Unless using the Onehanded Technique) Use Gloves When Handling Needles (Won’t
Prevent Injuries but May Lessen Chance of Transmitting Diseases) CONTROL OF C0MMUNICABLE DIESEASE 1. Notification 2. Epidemiological Investigation 3. Case finding; early dx and prompt treatment 4. Isolation and Quarantine 5. Disinfection; disinfestation 6. Medical Asepsis a. Handwashing b. Concurrent disinfection c. Personal protective equipments (PPEs) d. Barrier Cards/Placarding Objectives of CCD Restoration of health, reduce deaths and disability Interpretation of control measures to IFC for practice to prevent spread of CD. Promotion of health and prevention of spread of CD Diseases that require weekly monitoring: 1. Acute flaccid paralysis (AFP) polio 2. Measles 3. Severe acute diarrhea (SAD) 4. Neonatal tetanus 5. AIDS Diseases that require reporting w/in 24 hrs 1. Acute flaccid paralysis (AFP) polio ➢ 2. Measles Diseases targeted for eradication 1. Acute flaccid paralysis polio 2. Neonatal tetanus 3. Measles 4. Rabies Epidemiology Study of the occurrence and distribution of diseases in the population Patterns of occurrence of disease –frequency of disease occurrence Sporadic On and off occurrence of the disease Most of the time it is not found in the community One or two cases that occur are not related Endemic Persistently present in the community all year round Ex: malaria in Palawan Epidemic An unexpected increase in the number of cases of disease Pandemic Epidemic of a worldwide proportions Time Related Patterns of Occurrence cyclical variation a periodic increase in the number of cases of a disease a seasonal disease, an increase is expected or there is usual increase- dengue fever during rainy seasons are increased but it is not considered an epidemic because it is expected to rise at this particular time hot spot-a rising increase that may lead to an epidemic
Time Related Patterns of Occurrence Short time fluctuation A change in the frequency of occurrence of a disease over a short period of time Maybe (+) or (-) Secular variation A change in the frequency of occurrence of a diseae taking place over a long period of time Ex: a.) the change in the pattern of occurrence of polio after being eradicated in 2000, then sudden repport of cases in 2001 due to mutant restraints. b.) small pox virus-eradicated in 1979 (last case reported) and no another incidence as of today Types of Epidemiology Descriptive Epidemiology - concerned with disease frequency & distribution Analytic Epidemiology Is a study of the factors affecting occurrence and distribution of the disease. Ex. Epidemiologic investigation Therapeutic/Clinical Study of the efficacy of a treatment of a particular disease Ex. Clinical trial of a newly proposed therapeutic regimen Evaluation Epidemiology Study of the over-all effectiveness of a total/ comprehensive public health program. Ex. Evaluation of the under five clinic Note: We make use of the epidemiology in CHN in order to come up a community diagnosis and also to determine the effectiveness of a particular treatment Types of Epidemiologic Data Demographic data Demography is the study of population groups Ex. Population size and distribution Vital Statistics Environmental data Health services data Ex. Ratio between nurse and the population being served Ex. Degree of utilization of health facility/ service Epidemiologic Investigation 1st step- Statement of the problem 2nd step- Appraisal of facts – describing the epidemic in terms of time, place, person. 3rd step- formulation of hypothesis 4th step-Testing the hypothesis 5th step- Conclusion and recommendation TERMS Disinfection – pathogens but not spores are destroyed Disinfectant – substance use on inanimate objects Concurrent disinfection – ongoing practices in the care of the patient to limit or control the spread of microorganisms. Terminal disinfection – practices to remove pathogens from the patient’s environment
after his illness is no longer communicable FACTORS AFFECTING ISOLATION Mode of Transmission Source Status of the client’s defense mechanism Ability of client to implement precautions ISOLATION EPI Launched by DOH in cooperation with WHO and UNICEF last July 1976 Objective – reduce morbidity and mortality among infants and children caused by the six childhood immunizable diseases PD No. 996 (Sept. 16, 1076) – “ Providing for compulsary basic immunization for infants and children below 8 y/o PP No. 6 (April 3, 1996) – “ Implementing a United Nations goal on Universal Child Immunization by 1990” RA 7846 (Dec. 30, 1994) – immunization hepa B PD No. 4 (July 29, 1998) – “Declaring the period of September 16 to October 14, 1998 as Ligtas Tigdas Month and launching the Phil Measles Elimination Campaign” Legislation, Laws affecting EPI Proclamation No. 46 – “polio eradication project” Proclamation No. 1064 – AFP surveillance Proclamation No. 1066 – National Neonatal Tetanus Elimination Campaign EPI BCG - TB DPT – Diptheria, Pertussis, Tetanu OPV - Poliomyletis Hepatitis B Measles Immunization Contraindications -conditions that require hospitalization For DPT 2 and 3 – history of seizures/ convulsions within 3 days after the first immunization with DPT Nursing responsibility: ask how the child reacts to the first dose For infant BCG – clinical AIDS The following conditions are NOT contraindications: Fever up to 38.5 ºC Simple or mild acute respiratory infection Simple diarrhea without dehydration Malnutrition (it is indication for immunization) Schedule of immunization Infant BCG 0 to 11 months or 0 to 1 year at birth 0.05 ml (dose) – ID, right arm School entrance BCG When the child enters Grade 1 with or without scar on the right arm then still go on with the vaccination except if he is repeating Grade 1 Schedule of immunization DPT
3 doses, 4 weeks or 1 month interval Target age: 1 ½ to 11 months but child is eligible up to 6 years If 7 years old and above DT only not P 0.5 ml, IM, vastus lateralis Schedule of immunization OPV 3 doses, 4 weeks/1 month Target population: same as above, eligibility until Grade 6 2-3 drops, oral route *Feb 8-March 8: Oplan Polio Revival Drive No side effect, but advise the mother to avoid feeding the child for 30 minutes after the vaccine, if vomits within the 30 minute period, repeat the vaccination Schedule of immunization Hepa B 3 doses, 4 weeks Can be given at birth Target age 1 ½ to 11 months 0.5 ml, IM, vastus lateralis Patient may experience local tenderness Schedule of immunization Measles 9 to 11 months Most babies have protection because of maternal antibodies thus this vaccine is given at 9 months because the time where the maternal antibodies wear off, other virus if it still active it will kill the vaccine 0.5 ml, subcutaneous, any arm Measles Fever and measles rash lasting for 1 to 3 days within 2 weeks after immunization (modified measles) Immunization Fully Immunized Child when he received all the antigens that should be given in the first year of life (1 dose BCG, MV; 3 doses DPT, OPV, HB) Completely Immunized Child All vaccines given but went beyond 0ne year of age
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